OCCUPANCY PERMIT APPLICATION

OCCUPANCY PERMIT APPLICATION
Date of Application*

MonthDayYear
Date
BUILDING OR SPACE TO BE OCCUPIED
Business Name*
Address to be Occupied*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address to be Occupied Hidden
Business Phone*
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Sq. Ft. of Building/Space to be Occupied*
Automatic Sprinkler System Present?*
Fire Alarm System Present?*
Provide a detailed description of the business proposed. Include details of any special operations or processes that the business will perform:*
BUSINESS OWNER INFORMATION

THIS INFORMATION MUST BE CORRECT OR YOUR APPLICATION WILL BE RETURNED. CONTACT THE BUSINESS OWNER TO OBTAIN THE NECESSARY INFORMATION.
Business Owner Name*
(full name)
Business Owner Address*

Street Address

Street Address Line 2

CityState

Zip Code
Business Owner Address Hidden
Business Owner Phone*
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Business Owner Email*
example@example.com
BUILDING OWNER INFORMATION

THIS INFORMATION MUST BE CORRECT OR YOUR APPLICATION WILL BE RETURNED. CONTACT THE BUILDING OWNER TO OBTAIN THE NECESSARY INFORMATION.
Building Owner Name*
(Full Name)
Building Owner Address*

Street Address

Street Address Line 2

CityState

Zip Code
Building Owner Address Hidden
Building Owner Phone*
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Building Owner Email*
example@example.com
After Hours Emergency Contacts
Contact #1 Name*
(Full Name)
Contact #1 Phone*
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Key HolderBusiness OwnerManager
Contact #2 Name
(Full Name)
Contact #2 Phone
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Key HolderBusiness OwnerManager
Applicant Information & Signature
Signature of Applicant*

Clear
Print Full Name*
Applicant's Phone*
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Applicant's Email*
example@example.com
This application must be accompanied by a non-refundable $100.00 application fee. This application does not authorize occupancy. An occupancy permit will be issued after an inspection assures that the occupancy has no violations.
Payment Information

Fees Due*

Occupancy Permit Application Fee

This fee is NONREFUNDABLE & covers the first inspection plus one (1) re-inspection if necessary.

$100.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit or Debit Card

Company Name
Company Name on Card (if applicable)
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Phone*
Numbers only. No parentheses, dashes or spacesFormat: 0000000000.
Billing Email*
example@example.com
By signing below I hereby authorize Community Fire Protection District to charge my credit card for the amount shown above. I understand this fee is non-refundable.
Authorization Signature*

Clear
Please verify that you are human*
Should be Empty:

OCCUPANCY PERMIT APPLICATION

BUILDING OR SPACE TO BE OCCUPIED

BUSINESS OWNER INFORMATION

BUILDING OWNER INFORMATION

After Hours Emergency Contacts

Applicant Information & Signature

Payment Information

Credit or Debit Card